Evaluation Of Systolic Murmur Research Articles

Mobile subpulmonary membrane in a patient with hypertrophic cardiomyopathy and right ventricular mid-cavitary obstruction

A 51-year-old male was referred for evaluation of systolic murmur, at the left sternal border. An echocardiogram showed bi-ventricular hypertrophy ( Panel A and Supplementary data online, Video S1 ) without an obvious cause. In the para-sternal long axis view, there was no systolic anterior motion of anterior mitral leaflet, left ventricular outflow obstruction, or mitral regurgitation (Supplementary data online, Video S2 …

Evaluation of systolic murmurs using transthoracic echocardiography by anaesthetic trainees

Focused transthoracic echocardiography by anaesthetists in the peri-operative period has recently been described; the data suggest that the specific skills required can be obtained by non cardiology physicians with limited training. Aortic stenosis is known to increase significantly the peri-operative risk in non-cardiac surgery. This study aimed to assess the ability of echocardiography naive trainee anaesthetists to recognise and assess the severity of aortic stenosis after a set amount of training. Five trainees underwent 2 h of didactic and hands-on teaching in evaluation of the aortic valve, after which they scanned 20 patients each. Their results were compared with those obtained by an experienced cardiac anaesthetist with echocardiography training and qualifications. There was 100% concordance between trainees and the consultant for assessment of clinically significant aortic stenosis, with no cases of misdiagnosis. There was also 90-100% agreement (kappa statistic 0.8-1) between the consultant and each trainee's assessment of clinically significant aortic stenosis based on a peak aortic velocity > 3 m.sec(-1). Anaesthesia trainees can be successfully and rapidly trained to recognise and estimate the severity of aortic stenosis.

Evaluation of systolic murmurs by Doppler ultrasonography.

Non-invasive continuous and pulsed wave Doppler ultrasonography was performed in 102 consecutive patients with clinically ill defined systolic murmurs to differentiate between flow murmurs, mitral regurgitation, aortic stenosis, and ventricular septal defect, as well as to assess the severity of aortic stenosis. Diagnoses with the Doppler method were based on velocity, direction, and duration of flow signals and were subsequently verified by cardiac catheterisation in all patients. Multiple evaluations were made in 31 patients. Sensitivity and specificity were 0.87 and 0.77 in mitral regurgitation, 0.9 and 1.0 in aortic stenosis, and 1.0 and 1.0 in ventricular septal defect. In 67 patients the estimation of severity of aortic stenosis using the Doppler technique to calculate aortic pressure gradients from maximum flow velocity was significantly correlated with that determined at catheterisation. It is concluded that Doppler ultrasonography is a highly useful technique for the non-invasive evaluation of clinically ill defined systolic murmurs.